going to be much more expensive than you have been paying.” A drug recall can also have a sig-

nificant effect on the availability of a product, Ezerskis says. “We have had a few of our medications recalled, but fortunately these recalls have not yet caused a shortage or forced us to can- cel any cases.”

Diversify Suppliers While Dembny says there is little an ASC can do to foresee a price increase or shortage, there are ways for surgery cen- ters to prepare for those inevitabilities. “You always want to have more than

one avenue from where you can get drugs,” he says. “If there is a nationwide shortage of fentanyl, one of your sup- pliers may not have any, but if another anticipated the shortage and stocked up, it may be able to carry you through.

“While a primary wholesaler can be in place, using several wholesalers routinely can best position the facil- ity to be in line for services when dif- ficult times arrive,” Sones adds. It might be best

to leave the

stocking up of medications to sup- pliers, Sones says. “The temptation to respond to anticipated shortages by ‘overstocking’

is understand-

able. However, such a strategy fur- ther exacerbates the problem for all of us.” Having extra in stock on hand

sounds like a great idea, Dembny suggests, but not when an ASC lacks storage space or the extra money those supplies would require to be tied up in inventory. “The problem,” she adds, “is you never know what you are going to run short of.”

503B Outsourcing Facility Engage Physicians

When a price change or shortage forces an ASC to consider alternative medications, physician involvement is essential, Dembny says. “A good rela- tionship with your medical or anesthe- sia staff goes a long way. If you cannot get a drug or it is cost-prohibitive, you want to be able to work with them to identify other ways to safely take care of patients.” Ezerskis says she is fortunate to

have a strong relationship with her physicians. “We work with them to determine appropriate and viable alter- natives. Rather than think of solutions themselves, they like to be provided with options. If anyone is uncomfort- able with switching, we do not force a change and will keep working to find other solutions.”

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